Angles on the Guidelines

Eating disorder dietician Christine Byrne offers this perspective:

I don’t use the terms “overweight” or “obese” in my practice because they pathologize body size and stigmatize people in larger bodies, and because they’re based on body mass index, or BMI, which has racist origins and is a poor measure of health.

She only uses the words when discussing their presence and significance in the collection of treatment guidelines newly issued by the American Academy of Pediatrics.

Byrne points out the noticeable contrast between the new recommendations and those published back in 2016. At that time, the advice was to not put adolescents on weight-loss diets, either with or without pharmaceutical aids. Professionals were urged to emphasize positive body image and healthful everyday habits, and the guidance then did not even mention surgery.

She notes a lot of Americans, including many of her colleagues in the eating disorder field, are outraged by the new guidelines, which cannot help but have “an extremely negative impact on kids’ relationships with food and their bodies.” It is felt that eating disorders will multiply. Of course, not all troubled teens will become anorectic, but some will.

Byrne conceded that in the new guidelines, eating disorder screening is mentioned:

[P]ediatricians are told to ask about “unhealthy practices to lose weight,” inducing meal skipping, using diet pills or laxatives, or inducing vomiting. But eating disorder providers say this is totally inadequate in reducing eating disorder risk, since telling a kid or teenager to lose weight could inherently increase their risk of disordered eating behaviors, body image distress, and, potentially, an eating disorder.

A lot of people deplore the idea that, even when a young person does not appear to experience any health issues, doctors are being told to recommend weight loss. On the other hand, the family doctor is only one voice among many that assail the ears and spirits of vulnerable teens. Thanks to the ubiquitous presence of the internet in everyone’s pockets, it is easy for a young person to take lessons from peers who are experts in the arts of laxative use, voluntary vomiting, and worse.

Many professionals consulted by Byrne agree in their concern that eating disorders are…

[…] known to increase the risk of anxiety, depression, suicidality, substance use disorders, premature death, and serious issues at work, school, and in relationships. They can also have a negative impact on heart, bone, brain, digestive, and hormone health.

Obviously, nobody needs any of this.

Your responses and feedback are welcome!

Source: “The New Obesity Guidelines for Kids Are Appalling,”, 02/02/23
Image by Tanvir Alam/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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